Be A Bed Ahead

Purpose:
The goal is for the right Veteran to be pulled to the right level of care, with the right provider, and at the right time. By utilizing evidence based care and identifying best practices we reduced key aspects of a negative patient experience through delivery of patient-centered care.

Relevance/Significance:
Frontline nurses recognized an opportunity to improve patient safety, hospital revenue, and staff satisfaction, with a focus on the communication and flow of a patient through the admission process. By addressing these key root causes, indirect effects would include reducing waits for inpatient admission through the emergency departments, achieving timely and efficient transfer of patients from the emergency room, and intensive care unit to the medical/surgical units.

Strategy and Implementation:
We followed the VA lean healthcare methodology, VA-TAMMCS (Vision, Analyze, Team, Aim, Map, Measure, Change, Spread/Sustain) to analyze our situation. The first step was evaluating the flow process. Based upon the results of the risk priority matrix, we began measurement of the number of calls made and received per patient admission. The first test change was conducted where the ED charge nurse calls the nursing coordinator to setup the admission instead of the AOD (AOD is not a clinician).This allowed the patient's condition to be discussed, thus preventing the Veteran from being pushed to a unit that was an inappropriate level of care.The charge nurse filled out a simple card that contained the patient's vital information and the time the coordinator called. This process increased communication regarding the patient needs. The admitting nurse had 15 minutes to call for report. The nursing staff was educated on the pull vs. push system and Be A Bed Ahead system during morning huddles.

Evaluation:
•Press Ganey: Admission Speed improved Oct. ‘14 from 86.5 to Mar. ‘15 to 88.5, 2.31% change. 84% reduction of in average number of phone calls to admit a patient. Current Average time to call report is under 20 minutes for each inpatient unit, a compliance of 75%. Average Wait Time from ED Provider Decision to Admit -24 minutes/18% reduction in average number of minutes from Oct. ‘14 to Feb. ‘14

Implications for Practice:
This was an opportunity for a process improvement identified and developed by bedside nurses, creating autonomy in the nurses' personal practice. The handoff process is now streamlined, with increased efficiency and safety of the unit.